Best Health Insurance Companies for 2019

Because there are so many moving parts when it comes to picking the best health insurance, it’s hard to know where to start. However, one thing to keep in mind when you’re looking for the best health insurance companies is your desired level of coverage: What do you need covered, and what’s your budget? To help you find the top health insurance companies in your area (and in your budget), we’ve put together this tool.

Find the Best Health Insurance

Enter your ZIP code below and be sure to click at least 2-3 companies to find the very best rate.

Because there’s no “best” health insurance company for everyone, I’ll instead focus on how to find the best provider and plan for you. We’ll discuss how geography affects your choices and look at which health insurance companies have the best reputation for customer satisfaction in different areas of the country.

I’ll also cover how different types of health plans operate, what major medical plans must include, and special considerations that may apply when you’re shopping. Before we dive into those details, however, we want to go over the top health insurance companies by region and type of plan based on several recent stsudies.

Best Health Insurance Companies by Region

The following data was pulled from J.D. Power’s 2018 Member Health Plan Study, which examined more than 33,000 plan members’ satisfaction with coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service.

The JD Power survey covered 163 plans in 22 regions. All providers listed below were ranked above average in a given region.

The Best Health Insurance Plans in America

In a survey of more than 3,100 current health insurance customers, Insure.com’s 2018 health insurance ratings gave top honors to Horizon Blue Cross Blue Shield of New Jersey, followed by Emblem Health, Humana, Cigna, and Blue Shield of California.

Consumer Reports, meanwhile, looks at data from the nonprofit National Committee for Quality Assurance. According to NCQA’s 2018-2019 ratings, the following health insurance plans received the best overall scores:

You can search the NCQA ratings for the best health insurance plans in your area by selecting the plan type (Private, Medicare, or Medicaid) and your state.

Find the Best Health Insurance

Enter your ZIP code below and be sure to click at least 2-3 companies to find the very best rate.

How Geography Affects Your Health Insurance Choices

The reality of the U.S. health insurance industry means you may not have much latitude to choose your provider. How much choice you have almost entirely depends on where you live.

Generally, if you’re in a big city in a densely populated state, a good number of insurers will be competing for your business. Roughly half (48%) of Americans enrolled through Affordable Care Act marketplaces had access to three or more insurers in 2018, according to the Kaiser Family Foundation, with an average of 3.5 participating insurance companies per state.

But while New York’s health insurance exchange offers a variety of plans from a dozen different companies, in many rural areas, there may be a single dominant insurer. In fact, in 2018, eight states — Alaska, Delaware, Iowa, Mississippi, Nebraska, Oklahoma, South Carolina, and Wyoming — had just one participating insurer.

Experts say that while efforts by Congressional Republicans and the Trump administration to repeal, dismantle, or at the very least undercut key parts of the Affordable Care Act have weakened it somewhat, the ACA remains in place and fairly stable as of September 2018, and no county is without at least one insurer. Still, in some parts of the country, the best health insurance company for you may be the only one that will take your business.

Can Health Insurance Drop You?

This is a commonly asked question. As it currently stands, federal law prohibits health insurance companies from cancelling your coverage just because you’re sick, and prohibits health insurance providers from setting annual or lifetime financial limits on essential benefits.

Best Health Insurance Companies for Customer Satisfaction

If you’re lucky enough to live in an area with a lot of top health insurance companies offering competitively priced plans, you may be able to factor in an insurer’s reputation for providing satisfactory service. Be careful not to put too much stock in individual reviews of health care companies, however. They are highly dependent on very personal circumstances, and they are overwhelmingly negative across the board.

There are a few resources that allow you to get a wider, more reliable snapshot of the top health insurance companies. J.D. Power’s 2018 Member Health Plan Study ranks several providers by U.S. region. Insurers that come out at or near the top in several states include the Kaiser Foundation Health Plan and Blue Cross Blue Shield. (Be sure to check your specific region, as the same insurers that are in the top in some states may rank at the bottom in other states.)

Finding the Best Health Insurance Plan for You

If you’re in an area with limited choices or your preferred providers are too expensive, it’s still possible to zero in on a plan that will work for you, regardless of company. To do so, you’ll need to understand what types of plans are out there, what kind of coverage is already included in major medical health insurance plans, and whether you have special considerations that will affect your decision.

If your budget is the major driving force behind your decision, be sure to check out How to Find Affordable Health Insurance. You’ll find a more detailed discussion of the shopping process and how to find the most affordable plan you can without skimping on coverage.

Selecting the Right Type of Health Insurance Plan

One major factor to consider is the type of health care plan that makes sense for you. But keep in mind that your location will also affect how much choice you have regarding plan types, just like it does with providers.

Whatever plan type you choose, note that the ACA has made lifetime and annual benefit caps illegal. That means that, with the exception of non-ACA-regulated short-term health plans, you will no longer be on the hook for all of your costs after going over a certain dollar amount during a certain time period — a massive benefit for anyone with health conditions that require extensive, high-dollar care.

All plans will also include an out-of-pocket maximum that limits the amount you have to pay each year before your insurance will cover 100% of your remaining costs. The ACA requires all deductibles, coinsurance, copayments, or similar charges to go toward this limit; however, your premiums and any spending on non-essential health benefits are among charges that don’t count toward the limit. For 2019, individuals’ out-of-pocket maximums are capped at $7,900 on the federal marketplace, and family plan maximums are capped at $15,800.

HMO

HMOs (health management organizations) may be the most infamous type of health insurance plan. This is likely because they’re the most restrictive. With an HMO, you must receive your care within your HMO’s provider network, and you must go through your primary care physician for a referral if you need to see a specialist. If you receive care out of your network, you could be on the hook for the entire bill except in the case of an emergency.

Cost management is the main goal, and advantage, of going with an HMO. HMOs are more likely to charge flat copays instead of coinsurance. This means you could pay anywhere from roughly $5 to $25 each time you need any kind of medical care or prescription. However, you probably won’t have to pay a deductible before your insurance kicks in every year — these can average $250 to $500 for individuals or families, respectively, but may cost even $1,000 or more if you opt for a plan with lower monthly premiums.

The lack of deductible can make HMOs a good choice if you’re on a tight budget and live in a city with abundant quality medical facilities, especially if you’re relatively healthy and don’t need a lot of care from year to year. An HMO can also be a good choice if you know you’ll need a greater degree of routine care (such as for pregnancy) and all of your providers are available in network. However, if you know you’ll need a lot of specialized care, you might find an HMO frustratingly limiting — and very expensive if you suddenly need to go outside of your network.

PPO

PPOs (preferred provider organizations) give you much more latitude to choose your health providers. You don’t need to go through a single primary-care physician to receive a referral. Though you still pay less if you stay in your PPO network, you probably won’t have to pay the whole bill if you decide to go out of network. If you want to shop around for doctors or have a condition that demands specialized care, a PPO could be your best bet.

While lower costs are the main pro of an HMO, higher costs are the main con of a PPO. You’ll need to pay your deductible before your insurance kicks in. As I mentioned above, that can be as little as a couple hundred dollars a year, or more than $1,000 if you opted for a plan with a lower monthly premium.

Ultimately, PPOs are usually the best choice for anyone who prizes flexibility over cost savings. If you have a complicated medical history and may need to see specialists, particularly out of network, a PPO can actually save you money over a more restrictive HMO. In general, however, you’ll probably pay a bit more out of pocket to have a greater degree of choice and control over your care with a PPO.

Hybrid Plans: POS Plans and EPOs

POS (point of service) plans aim to blend the characteristics of HMOs and PPOs. You’ll need to go through a primary-care physician for referrals, much like an HMO. However, a POS plan also allows you to receive care outside your network like a PPO.

A POS plan could be right for you if you really like your primary physician and don’t mind routing your care through him, but want to keep out-of-network flexibility. Costs tend to fall in between those of HMOs, which are on the cheaper end, and PPOs, which are more expensive.

EPOs (exclusive provider organizations) are the least common plan type. They’re also a blend of PPOs and HMOs. Like HMOs, you must receive care within your network. But like PPOs, you won’t need to go through your primary care physician to get a referral. However, you may need to get preauthorization for more expensive services.

EPOs may be a good choice if you expect to stay in network but don’t want to deal with referral paperwork. Costs also tend to be in the middle between HMOs and PPOs.

Short-term Health Plans

Unlike the other four plans on this list, short-term health plans are not major medical plans. They are inexpensive, stopgap plans meant to hedge against catastrophic health disasters, maybe while you’re between jobs or because you are shopping outside of open enrollment. Your deductible will likely be very high.

The major pro here is that short-term plans are the cheapest plans you can get. But ACA regulations don’t apply to short-term health plans, which are the only ones for sale when it isn’t open enrollment.

Buyer beware: These plans are not required to provide benefits such as preventive care, and there will be a cap on benefits — this is no longer allowed for major medical plans. You may not even qualify if you have pre-existing health conditions, which other health plans must accommodate under the ACA.

Ultimately, we don’t recommend short-term health plans unless you are young, healthy, and need coverage to hedge against the high cost of emergency care simply because you missed open enrollment. Otherwise, the fine print and exclusions on these plans make them a very flimsy substitute for major medical insurance.

Essential Health Benefits

One of the major requirements of the ACA is that all major medical insurance plans you can purchase as an individual (excluding short-term health insurance, discussed above) must cover a set of 10 essential health benefits. These benefits apply regardless of whether you buy your plan through a state or federal health exchange, from an insurance broker, or directly from an insurance company. They are as follows:

Ambulatory (outpatient) care: This is care you receive on an outpatient basis — that is, without getting admitted to a hospital. It includes standard doctor’s office appointments and in-home health visits.

Emergency care: This includes any care you receive for a potentially debilitating or fatal condition. Ambulance and emergency-room treatment are common examples.

Hospital care: Any care you receive as a patient at a hospital or skilled nursing facility is covered. This includes lab work, surgery, medications, and any other treatment you receive as a patient.

Maternal health and newborn care: This includes all prenatal care for expectant mothers, as well as labor, delivery, postnatal care, and newborn care.

Mental health care and addiction treatment: Whether inpatient or outpatient, this includes any care necessary to diagnose, monitor, or treat mental illness or addiction. Some plans limit treatment to a certain number of days.

Pediatric services: This includes all care provided to children, including yearly checkups, vaccinations, dental care, and vision care.

Prescriptions: Plans must cover at least one medication in every federal category and class of prescription drugs. Insurers still have preferred-drug lists and may require generics over name-brand drugs, among other restrictions.

Preventive care: This includes physicals, screenings, immunizations and other services meant to prevent or detect illness or other conditions, as well as the management of chronic conditions.

Rehabilitative and habilitative care: These services help you gain or regain abilities limited or lost to or limited by injuries, illness, or other conditions. Examples might include physical therapy, occupational therapy, and speech therapy. Some plans limit treatment to a certain number of sessions a year.

Will Health Insurane Cover Oral Surgery?

Typically, your health insurance policy may cover oral surgery if it is deemed medically necessary. This could include dental care from a severe mouth injury or certain diseases. If your needs are deemed more cosmetic in nature, then your health insurance provider might not be able to help.

How Do I Get Health Insurance if I’m Unemployed or Have a Low Income?

If you’re unemployed or on a very tight budget, you may still be able to get health insurance through open enrollment. Depending on your income, you may qualify for free or inexpensive coverage through Medicaid. Also, the Children’s Health Insurance Program (CHIP) and other community health centers provide assistance as well.

Special Considerations: Looking Beyond Essential Benefits

While the list of essential health benefits seems exhaustive, there are still a number of factors that can affect your coverage depending on where you live and which provider and plan you choose. For these issues, it’s especially important to read the fine print to see what’s covered when you’re shopping for a plan.

Staying in Network

If you have an existing relationship with a certain health care provider and want to maintain it, never assume that provider will be in network on your new plan. Likewise, if you don’t want to be restricted to a small number of providers or certain hospitals, you’ll need to shop carefully. For instance, all doctors at a certain hospital (or even within a certain practice) may not be members of the same insurance networks.

Experts say many insurers are cutting costs by narrowing their provider networks. While this might be a good thing if you don’t need much care and want to save money, it increases the chances that you’ll have to pay steep out-of-pocket costs for out-of-network care.

Prescription Drugs

Yes, prescription drugs must be covered under the ACA, as noted above. But there’s no guarantee that the specific drugs you take will be covered, and what you’ll pay still varies by plan.

If you take certain medications, you’ll want to check a potential plan’s preferred-drug list, or formulary, to see whether it’s covered. This information is typically available on an insurer’s website. If your drug isn’t covered, your doctor can help you request it by explaining how it’s necessary for your treatment, but the process may not be a quick one, and there are no guarantees.

If you know you’ll need prescriptions filled regularly, you’ll also want to pay attention to cost. Your plan will likely require either coinsurance or a copay for prescriptions. Coinsurance means you pay a certain percentage of each drug’s cost (around 30% is typical). If you have a copay, you’ll pay a certain fixed amount (usually $10-$30) when you need a prescription, but it’s independent of the drug’s price. That usually makes copays a better bet if you know the drugs you take are expensive.

Mental Health Coverage

Again, some mental health care is required in every major medical plan. But beyond that, what kind of services are covered can vary tremendously by state.

If you have a specific need, you’ll need to wade into the fine print of a plan’s benefits summary to determine whether you’ll be covered. And if you want to see a specific provider, such as a certain therapist or psychiatrist, you’ll need to make sure he or she is in your network. It’s not uncommon for psychiatrists to refuse joining insurance networks to manage high demand and combat low reimbursements compared with other services.

Rehabilitative and Habilitative Care

Like mental health care, rehabilitative and habilitative care is more of a gray area for insurers. Even though some coverage is required, what’s covered and the limits on that coverage will vary by state and by plan.

Experts say those with chronic conditions need to pay especially close attention to the fine print. Because treatment tends to be more expensive, insurers have greater incentive to cap these benefits or skip them entirely. So while your physical therapy for a back injury may be entirely covered, speech therapy for your autistic child may not be.

The Bottom Line

Shopping through the best health insurance companies is a complex process, but well worth it in the end. You might need to look into multiple providers and review their policy prices before you find one that matches your needs. Another thing to consider is the company’s online reputation as well as customer support. This can be a huge indicator in how your experience might turn out.

Find the Best Health Insurance

Enter your ZIP code below and be sure to click at least 2-3 companies to find the very best rate.

Company

Our Brands

Advertising Disclosure: TheSimpleDollar.com has an advertising relationship with some of the offers included on this page. However, the rankings and listings of our reviews, tools and all other content are based on objective analysis. The Simple Dollar does not include all card/financial services companies or all card/financial services offers available in the marketplace. For more information and a complete list of our advertising partners, please check out our full Advertising Disclosure. TheSimpleDollar.com strives to keep its information accurate and up to date. The information in our reviews could be different from what you find when visiting a financial institution, service provider or a specific product's website. All products are presented without warranty.